April 2009
Volume 50, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2009
Simultaneous Deep Anterior Lamellar Keratoplasty (DALK) and Limbal Transplantation Using an Artificial Anterior Chamber Device
Author Affiliations & Notes
  • S. Shimmura
    Ophthalmology, Keio Univ School of Medicine, Tokyo, Japan
  • S. Hato
    Ophthalmology, Keio Univ School of Medicine, Tokyo, Japan
  • Y. Matsumoto
    Ophthalmology, Keio Univ School of Medicine, Tokyo, Japan
  • T. Kawakita
    Ophthalmology, Keio Univ School of Medicine, Tokyo, Japan
  • K. Tsubota
    Ophthalmology, Keio Univ School of Medicine, Tokyo, Japan
  • Footnotes
    Commercial Relationships  S. Shimmura, None; S. Hato, None; Y. Matsumoto, None; T. Kawakita, None; K. Tsubota, None.
  • Footnotes
    Support  None.
Investigative Ophthalmology & Visual Science April 2009, Vol.50, 622. doi:
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      S. Shimmura, S. Hato, Y. Matsumoto, T. Kawakita, K. Tsubota; Simultaneous Deep Anterior Lamellar Keratoplasty (DALK) and Limbal Transplantation Using an Artificial Anterior Chamber Device. Invest. Ophthalmol. Vis. Sci. 2009;50(13):622.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: : Ocular surface disease with stromal involvement requires both an optical keratoplasty and stem cell transplantation. Penetrating keratoplasty (PKP) is a poor indication due to the high risk of graft rejection, while deep anterior lamellar keratoplasty (DALK) offers full stromal transplantation without the risk of rejection. We report a novel technique using an artificial anterior chamber to design custom-thickness donor buttons and thin limbal rings.

Methods: : Four eyes of 3 patients with gelatinous drop-like dystrophy (GDLD: 2 eyes), ocular cicatricial pemphigoid (OCP) and Stevens Johnson syndrome (SJS) underwent simultaneous DALK and kerato-limbal allograft (KLAL). All patients had a Schirmer test value of at least 3 mm, and normal lid anatomy. DALK was performed by the viscodissection technique, followed by 360-degree KLAL. Donor corneas were fixed to an artificial chamber to produce thin-section (100 µm) donor limbal tissue. KLAL donors were fixed at the outer rim using 10-0 nylon, which were removed after 2 to 4 weeks to produce a seamless ocular surface.

Results: : All patients were followed for at least 6 months (average 13 months). A corneal epithelial phenotype was obtained in all eyes, with occasional epithelial defects observed in the SJS patient. KLAL donor tissue adapted to the recipient limbal tissue to recreate a smooth ocular surface, with normal tear meniscus observed in all patients. Visual acuity improved by more than 2 lines of vision in all eyes. No incidence of graft rejection or secondary glaucoma was observed.

Conclusions: : Artificial anterior chambers are useful in designing donor grafts for ocular surface reconstruction by simultaneous DALK and KLAL.

Keywords: transplantation • cornea: clinical science 
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